Diagnosis and differential diagnosis of acromegaly
Endocrinology / / August 12, 2017
In the advanced stage of the disease when the patient becomes very characteristic appearance, the disease diagnosis is not difficult, especially if the patient himself indicates an increase in limb size, head, and so on. N. At the beginning of the disease, when the disfigurement of patients has not yet gone farand patients treated with complaints of headaches, menstrual disorders or pain in the hands and others., to establish the correct diagnosis requires careful and deliberate examination.A long slow development of the disease, patients often do not notice the gradual change in facial features and the claim that they "have always been so."In these cases, most of assistance can view photos of patients for a number of years, sometimes allows to specify the time of disease onset.
The diagnosis of the disease, in addition to the typical subjective and objective signs of illness cited above, is of paramount importance X-ray examination, which gives an idea of the bone changes.The most significant is the
great diagnostic value also have other radiological signs of acromegaly, in particular changes in the spine.
Just as in the diagnosis of hormonally inactive pituitary tumors, the diagnosis of acromegaly is very important ophthalmologic research, especially the dynamic monitoring of changes in visual fields.Has revealed bitemporal hemianopsia half of patients with acromegaly.
biochemical and hormonal studies play a small role in the diagnosis of acromegaly.A known value in the diagnosis of acromegaly in the active phase is defined as the growth hormone in the blood and some biochemical parameters.
In the early stages of acromegaly when patients with impaired function of gonads (amenorrhea in women), headaches, and gradually occurring changes in appearance are not noticed either by the patients themselves or their surroundings, it may be necessary in the differential diagnosis of acromegaly and hormonally inactive chromophobepituitary adenoma.Compare photos of patients for a number of years and the presence of characteristic of acromegaly skeletal changes radiologically detectable, allow us to establish the correct diagnosis.
distinguish acromegaly from Paget's disease, often disfiguring patients, allows the absence of the last disease of soft tissue changes, it changes with the presence of only in individual bones with typical rearrangement of the bone structure.
In some cases it may be necessary differential diagnosis of acromegaly and the so-called pachydermia-periostoza.This rare disease occurs in young men and shows sharp thickening of fingers, limbs and an increase in thickening of the skin, especially on the face, hypertrophy of the sebaceous and sweat glands.When pachydermia-periostoze no changes in the bones of the skull.
If the diagnosis of acromegaly is usually not significant difficulties, the solution of the problem is sometimes difficult process of activity.Due to the fact that the disease is often characteristic for a long period of many years, over a relatively short period of time is not always possible to determine whether there is a progressive increase of the limbs and other parts of the body, and whether the tumor growth progresses.In this regard, of particular importance is the systematic monitoring of changes in visual fields.
indicator of activity of acromegaly is the emergence of headaches in those patients in whom they had previously lacked and ceased after treatment, as well as the weighting of metabolic disorders, in particular the development of diabetes or its weighting.
In the active phase of acromegaly also indicates elevated levels of inorganic phosphorus in blood serum as a result of bone demineralization.
In recent years, the technique that allows using art catheterization.brachialis and forearm veins to identify the change of tissue metabolism.In the active phase of acromegaly there is a greater capture of tissue oxygen, reducing the arteriovenous difference in the content of free fatty acids, decrease in response to vnutriarterialnoe insulin.
New perspectives in the diagnosis of acromegaly open developed in recent years, highly sensitive immunological methods for determining the growth hormone in the blood) has been established that in patients with acromegaly in the active phase of growth hormone in the blood content is significantly increased, while in remission, it may be normal.After the X-ray effective level of growth hormone in the blood decreases.
- pituitary dwarfism
- clinical picture of acromegaly
- treatment of acromegaly
- syndrome Morgagni - Stewart - Morel (MORGAGNI - MOREL - STEWART)
- tumors of the anterior pituitary
course and prognosis
Acromegaly is often slow gradually progressive course.In this disease can occur long - up to 50 years.Some authors suggest that spontaneous remission may occur in acromegaly.Growth eosinophilic adenoma while sometimes lasts, but there are no signs of growth of the body.
Less common forms of acromegaly, progressing relatively quickly and lead to the death of patients within 3-5 years of onset.Such forms are most often caused by the presence of "atypical" adenomas or rare cancers adeno-pituitary.
In later stages of the disease, when in connection with the compression of the anterior pituitary tumor is reduced production of ACTH and develops gipokortitsizm, patients makes it particularly susceptible to intercurrent diseases, in particular to infections that can cause death.
In some cases, death occurs due to heart failure, which develops due to degenerative changes in the hypertrophied myocardium.
patients Death may occur due to necrosis of the tumor or compression of its vital centers of the brain.